Tracie Lee Jackson, RDN, LMNT, CDCES
Dietitian, Registered in Ocala, FL. Individual provider (NPI-1).
NPI number1982807715
StatusActive
Last updated in NPPESApr 29, 2024
Details
- NPI
- 1982807715
- Entity type
- Individual (NPI-1)
- Name
- Tracie Lee Jackson
- Credential
- RDN, LMNT, CDCES
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 8, 2007
- Certification date
- Apr 29, 2024
- Last updated
- Apr 29, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 12865 | FL | Yes |
| 133V00000X | Dietitian, Registered | 347 | NE |
Practice location
1440 Sw 3rd AveOcala, FL 34471-6513
Phone 352-402-5295
Mailing address
Po Box 127Herman, NE 68029-0127
Phone 402-456-7876
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